HEMODYNAMIC-EFFECTS OF PLASMA-EXCHANGE IN SEPTIC PATIENTS - PRELIMINARY-REPORT

To assess the effects of plasma exchange on the hemodynamic performanc e of septic patients, we studied 12 septic patients (11 males and 1 fe male, age range 19-64, mean 39 +/- 17 years). After cardiovascular sta bilization, plasma exchange was performed in the spontaneous mode via a femorofemoral arteriovenous shunt; during the treatment the infusion rate of cardiovascular drugs and the mechanical ventilation setting w ere not modified. Heart rate, pulmonary artery occlusion pressure, and peripheral vascular resistance did not change significantly. The stro ke volume index increased significantly (from 49 +/- 9 to 60 +/- 9 ml/ min/m(2); p < 0.05) as well as the cardiac index (from 5.5 +/- 1.2 to 6.3 +/- 0.8 liters/min/m(2), the oxygen delivery (from 785 +/- 166 to 872 +/- 118 ml/min/m(2); p < 0.05), and the left ventricular stroke wo rk index/pulmonary artery occlusion pressure ratio (from 4.03 +/- 1.92 to 5.07 +/- 2.54; p < 0.05). The oxygen consumption did not change. F our patients survived. In conclusion, in our patients plasma exchange was associated with an improvement in cardiac function, possibly due t o the elimination of some sepsis mediator(s) with negative inotropic p roperties.